Rollover Request— 529 College Savings Plan

1 Print Reset Save Questions? Go to or call 800-544-1914. Rollover request 529 College Savings plan Use this form to initiate a Rollover or deposit of your 529 College Savings plan , Coverdell education Savings account, a qualified Savings Bond, or another 529 College Savings plan ( 529 plan ) to a 529 plan at Fidelity. Type on screen or fill in using CAPITAL letters and black ink. If you need more room for information or signatures, make a copy of the relevant page. Helpful to Know A. ccording to IRS regulations, you are eligible to roll Y. our current 529 plan administrator may require specific over from another 529 plan once every 12 months forms or signatures to roll over your 529 plan assets without changing the beneficiary. To be valid, a Rollover to Fidelity. The administrator may also send you a from another 529 plan must be made within 60 days of Rollover check directly. Check with your current 529 plan the distribution from the other 529 plan . administrator to verify requirements.

2 S. ubmit this form directly to Fidelity, not to the 529 plan D. o NOT use this form to change the beneficiary on your administrator from which you are requesting the funds 529 plan . To change the beneficiary, visit to be transferred. to complete the transaction online or to obtain the I f you have already received a check from your 529 correct form. You may not change the beneficiary on plan , include it with this form. a custodial 529 plan . I f you do not have a check yet, Fidelity will contact I mportant: You must have an existing Fidelity- the plan administrator and instruct it to liquidate managed 529 account prior to submitting this request . and transfer the funds directly to us. Fidelity is not You can open a new account online at responsible for market fluctuation on requests with openaccount, or complete a 529 College Savings new written liquidation instructions. account application and submit it along with this form. Y. ou are responsible for providing Fidelity with the If you are rolling over a UGMA/UTMA 529 plan , you principal and earnings breakdown of the amount of must establish a Fidelity-managed UGMA/UTMA 529.

3 This Rollover . If we do not receive this information, we plan account for the same beneficiary. are required by law to treat the entire Rollover amount as earnings in the 529 account. See Section 3 for documentation requirements. 1. Fidelity-managed 529 plan Information Participant (Owner)/Authorized Individual Fidelity 529 Account Number Name Social Security or taxpayer ID Number This phone number may be used if we have Daytime Phone questions, but will not be used to update your account information. Beneficiary Student Information Name Social Security or taxpayer ID Number Date of Birth MM DD YYYY. Form continues on next page. Page 1 of 4 007980501. 2. R. ollover between Fidelity-managed 529 Plans Complete only if both accounts are held with Fidelity. Fidelity 529 Account Number 529 Beneficiary Name Provide the account number of the account to be rolled over and the beneficiary name on that account. The name must match the beneficiary named in Section 1. Full Rollover Default if no other information indicated below.

4 Skip to Section 5. Attach extra sheets Partial Rollover Transfer only this amount. for additional portfolio listings. Portfolio Dollar Amount . Indicate at least one $ . OR ALL. portfolio name. If the amount of your request Portfolio Dollar Amount . is equal to or greater than your portfolio $ . OR ALL. value, we will send only Portfolio Dollar Amount the available balance.. $ . OR ALL. Portfolio Dollar Amount . $ . OR ALL. Total Dollar Amount $ . 3. 60-Day Rollover from a 529 plan Not Administered by Fidelity Complete only if you have received a check from your 529 plan to include with this form. Check the appropriate box as to the type of Rollover , and provide the specified documentation so that your principal and earnings amounts are appropriately recorded. Until such time as Fidelity receives the specified documentation, we must, by law, treat the entire amount of the contribution as earnings in the 529 plan account receiving the distribution. R. ollover from a Coverdell education Savings account Provide an account statement issued by the financial institution that acted as trustee or custodian of the account, showing basis and earnings in the account.

5 Rollover from the redemption of qualified Savings Bonds Provide an account statement or Form 1099-INT. issued by the financial institution that redeemed the bonds, showing interest from the redemption of the bonds. Rollover from another 529 plan Provide a statement issued by the distributing 529 program, showing the earnings portion of the distribution. Form continues on next page. Page 2 of 4 007980502. 4. Transfer of Assets from a 529 plan Not Administered by Fidelity Check the appropriate box as to the type of 529 plan account you are requesting to transfer to Fidelity. For an account owned by a trust, provide the trustee's information. For an UGMA/UTMA account, provide the custodian's information. Fidelity will request the additional required principal and earnings documentation from the current 529 plan administrator on your behalf during the transfer process. If we do not receive this information, we are required, by law, to treat the entire Rollover amount as earnings in the 529 account.

6 Transferring Account Information Check the type of Individual 529. 529 account you are requesting to transfer Joint 529. to Fidelity. Trust 529. UGMA/UTMA 529. Coverdell education Savings account Transferring 529 Account Number Participant/Trustee Name Social Security or taxpayer ID Number Trust Name if applicable Social Security or taxpayer ID Number Beneficiary Name Social Security or taxpayer ID Number Transferring Firm Information Note: If you are Transferring Firm Name requesting a transfer from a Coverdell education Savings Contact Person account, you may need to contact the transferring Daytime Phone Extension firm to request a liquidation. Transferring Firm Address City State ZIP Code Transfer Instructions Check only one. Full Liquidation Liquidate and transfer my entire account. Skip to Section 5. Partial Liquidation Liquidate and transfer only a part of my account, as detailed below: Attach extra sheets Portfolio Dollar Amount . for additional portfolio listings.

7 $ . OR ALL. Portfolio Dollar Amount . $ . OR ALL. Portfolio Dollar Amount . $ . OR ALL. Portfolio Dollar Amount . $ . OR ALL. Total Dollar Amount $ . Form continues on next page. Page 3 of 4 007980503. 5. Signature All owners of both accounts must sign this form By signing below, you: C. ertify that you have read the Fact Kit and Otherwise, a change in beneficiary is and accompanied by principal and earnings Participation Agreement. required if a transaction is to be considered documentation. If Fidelity does not receive a Rollover . All rollovers must be completed this information, we are required to treat U. nderstand that IRS regulations allow one within 60 days of the time of distribution or the entire Rollover amount as earnings in Rollover per beneficiary during a 12-month from when the transfer leaves the account the 529 account receiving the Rollover . period without changing the beneficiary. PRINT OWNER/AUTHORIZED INDIVIDUAL NAME MEDALLION SIGNATURE GUARANTEE.

8 OWNER/AUTHORIZED INDIVIDUAL SIGNATURE. X. SIGN. TODAY'S DATE MM/DD/YYYY. X. D AT E. PRINT OWNER/AUTHORIZED INDIVIDUAL NAME MEDALLION SIGNATURE GUARANTEE. OWNER/AUTHORIZED INDIVIDUAL SIGNATURE. X. SIGN. TODAY'S DATE MM/DD/YYYY. X. D AT E. Delivering Firm Use Only To the previous trustee or custodian: Please be advised that Fidelity Brokerage Services LLC has established a 529 account to receive the distribution from the 529 plan referenced in Section 4. Fidelity Brokerage Services LLC will accept the proceeds from the 529 plan you administer and place the proceeds in a brokerage account that will hold units of interest in a Fidelity-managed 529 plan . Please provide documentation so that principal and earnings amounts are appropriately recorded. Successor Custodian/Trustee Signature Did you sign the form? Send the ENTIRE form and any required Regular mail Overnight mail documents to Fidelity Investments. Fidelity Investments Fidelity Investments Attn: CPSC Attn: CPSC.

9 Questions? Go to or call 800-544-1914. PO Box 770001 100 Crosby Parkway KC1K. Make checks payable to: Fidelity Brokerage Services LLC Cincinnati, OH 45277-0015 Covington, KY 41015. On this form, Fidelity means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC. (06/20). Page 4 of 4 007980504.